tetano
Editor, Senior Moderator
Diabetes Care
. 2022 Jan 19;dc212102.
doi: 10.2337/dc21-2102. Online ahead of print.
Inflammation, Hyperglycemia, and Adverse Outcomes in Individuals With Diabetes Mellitus Hospitalized for COVID-19
Alexi Vasbinder[SUP] 1 [/SUP], Elizabeth Anderson[SUP] 1 [/SUP], Husam Shadid[SUP] 2 [/SUP], Hanna Berlin[SUP] 2 [/SUP], Michael Pan[SUP] 2 [/SUP], Tariq U Azam[SUP] 1 [/SUP], Ibrahim Khaleel[SUP] 2 [/SUP], Kishan Padalia[SUP] 2 [/SUP], Chelsea Meloche[SUP] 2 [/SUP], Patrick O'Hayer[SUP] 2 [/SUP], Erinleigh Michaud[SUP] 2 [/SUP], Tonimarie Catalan[SUP] 1 [/SUP], Rafey Feroze[SUP] 2 [/SUP], Pennelope Blakely[SUP] 1 [/SUP], Christopher Launius[SUP] 1 [/SUP], Yiyuan Huang[SUP] 3 [/SUP], Lili Zhao[SUP] 3 [/SUP], Lynn Ang[SUP] 4 [/SUP], Monica Mikhael[SUP] 4 [/SUP], Kara Mizokami-Stout[SUP] 4 [/SUP], Subramaniam Pennathur[SUP] 5 [/SUP], Matthias Kretzler[SUP] 5 [/SUP], Sven H Loosen[SUP] 6 [/SUP], Athanasios Chalkias[SUP] 7 [/SUP], Frank Tacke[SUP] 8 [/SUP], Evangelos J Giamarellos-Bourboulis[SUP] 9 [/SUP], Jochen Reiser[SUP] 10 [/SUP], Jesper Eugen-Olsen[SUP] 11 [/SUP], Eva L Feldman[SUP] 12 [/SUP], Rodica Pop-Busui[SUP] 4 [/SUP], Salim S Hayek[SUP] 1 [/SUP], ISIC Study Group:; Salim S Hayek, Pennelope Blakely, Hanna Berlin, Tariq U Azam, Husam Shadid, Michael Pan, Patrick O'Hayer, Chelsea Meloche, Rafey Feroze, Kishan J Padalia, Elizabeth Anderson, Danny Perry, Abbas Bitar, Rayan Kaakati, Yiyuan Huang, Lili Zhao, Jochen Reiser, Beata Samelko, Alex Hlepas, Priya P Patel, Xuexiang Wang, Jesper Eugen-Olsen, Izzet Altintas, Marius Stauning, Morten Baltzer Houlind, Mette B Lindstrøm, Hejdi Gamst-Jensen, Line Jee Hartmann Rasmussen, Jan O Nehlin, Thomas Kallemose, Imran Parvaiz, Christian Rasmussen, Ove Andersen, Jens Tingleff, Evangelos J Giamarellos-Bourboulis, Maria-Evangelia Adami, Nicky Solomonidi, Maria Tsilika, Maria Saridaki, Vasileios Lekakis, Sven H Loosen, Tom Luedde, Verena Keitel, Athanasios Chalkias, Eleni Arnaoutoglou, Ioannis Pantazopoulos, Eleni Laou, Konstantina Kolonia, Anargyros Skoulakis, Frank Tacke, Pinkus Tober-Lau, Raphael Mohr, Florian Kurth, Leif Erik Sander, Christoph Jochum
Affiliations
Abstract
Objective: Diabetes mellitus (DM) is a major risk factor for severe coronavirus disease 2019 (COVID-19) for reasons that are unclear.
Research design and methods: We leveraged the International Study of Inflammation in COVID-19 (ISIC), a multicenter observational study of 2,044 patients hospitalized with COVID-19, to characterize the impact of DM on in-hospital outcomes and assess the contribution of inflammation and hyperglycemia to the risk attributed to DM. We measured biomarkers of inflammation collected at hospital admission and collected glucose levels and insulin data throughout hospitalization. The primary outcome was the composite of in-hospital death, need for mechanical ventilation, and need for renal replacement therapy.
Results: Among participants (mean age 60 years, 58.2% males), those with DM (n = 686, 33.5%) had a significantly higher cumulative incidence of the primary outcome (37.8% vs. 28.6%) and higher levels of inflammatory biomarkers than those without DM. Among biomarkers, DM was only associated with higher soluble urokinase plasminogen activator receptor (suPAR) levels in multivariable analysis. Adjusting for suPAR levels abrogated the association between DM and the primary outcome (adjusted odds ratio 1.23 [95% CI 0.78, 1.37]). In mediation analysis, we estimated the proportion of the effect of DM on the primary outcome mediated by suPAR at 84.2%. Hyperglycemia and higher insulin doses were independent predictors of the primary outcome, with effect sizes unaffected by adjusting for suPAR levels.
Conclusions: Our findings suggest that the association between DM and outcomes in COVID-19 is largely mediated by hyperinflammation as assessed by suPAR levels, while the impact of hyperglycemia is independent of inflammation.
. 2022 Jan 19;dc212102.
doi: 10.2337/dc21-2102. Online ahead of print.
Inflammation, Hyperglycemia, and Adverse Outcomes in Individuals With Diabetes Mellitus Hospitalized for COVID-19
Alexi Vasbinder[SUP] 1 [/SUP], Elizabeth Anderson[SUP] 1 [/SUP], Husam Shadid[SUP] 2 [/SUP], Hanna Berlin[SUP] 2 [/SUP], Michael Pan[SUP] 2 [/SUP], Tariq U Azam[SUP] 1 [/SUP], Ibrahim Khaleel[SUP] 2 [/SUP], Kishan Padalia[SUP] 2 [/SUP], Chelsea Meloche[SUP] 2 [/SUP], Patrick O'Hayer[SUP] 2 [/SUP], Erinleigh Michaud[SUP] 2 [/SUP], Tonimarie Catalan[SUP] 1 [/SUP], Rafey Feroze[SUP] 2 [/SUP], Pennelope Blakely[SUP] 1 [/SUP], Christopher Launius[SUP] 1 [/SUP], Yiyuan Huang[SUP] 3 [/SUP], Lili Zhao[SUP] 3 [/SUP], Lynn Ang[SUP] 4 [/SUP], Monica Mikhael[SUP] 4 [/SUP], Kara Mizokami-Stout[SUP] 4 [/SUP], Subramaniam Pennathur[SUP] 5 [/SUP], Matthias Kretzler[SUP] 5 [/SUP], Sven H Loosen[SUP] 6 [/SUP], Athanasios Chalkias[SUP] 7 [/SUP], Frank Tacke[SUP] 8 [/SUP], Evangelos J Giamarellos-Bourboulis[SUP] 9 [/SUP], Jochen Reiser[SUP] 10 [/SUP], Jesper Eugen-Olsen[SUP] 11 [/SUP], Eva L Feldman[SUP] 12 [/SUP], Rodica Pop-Busui[SUP] 4 [/SUP], Salim S Hayek[SUP] 1 [/SUP], ISIC Study Group:; Salim S Hayek, Pennelope Blakely, Hanna Berlin, Tariq U Azam, Husam Shadid, Michael Pan, Patrick O'Hayer, Chelsea Meloche, Rafey Feroze, Kishan J Padalia, Elizabeth Anderson, Danny Perry, Abbas Bitar, Rayan Kaakati, Yiyuan Huang, Lili Zhao, Jochen Reiser, Beata Samelko, Alex Hlepas, Priya P Patel, Xuexiang Wang, Jesper Eugen-Olsen, Izzet Altintas, Marius Stauning, Morten Baltzer Houlind, Mette B Lindstrøm, Hejdi Gamst-Jensen, Line Jee Hartmann Rasmussen, Jan O Nehlin, Thomas Kallemose, Imran Parvaiz, Christian Rasmussen, Ove Andersen, Jens Tingleff, Evangelos J Giamarellos-Bourboulis, Maria-Evangelia Adami, Nicky Solomonidi, Maria Tsilika, Maria Saridaki, Vasileios Lekakis, Sven H Loosen, Tom Luedde, Verena Keitel, Athanasios Chalkias, Eleni Arnaoutoglou, Ioannis Pantazopoulos, Eleni Laou, Konstantina Kolonia, Anargyros Skoulakis, Frank Tacke, Pinkus Tober-Lau, Raphael Mohr, Florian Kurth, Leif Erik Sander, Christoph Jochum
Affiliations
- PMID: 35045184
- DOI: 10.2337/dc21-2102
Abstract
Objective: Diabetes mellitus (DM) is a major risk factor for severe coronavirus disease 2019 (COVID-19) for reasons that are unclear.
Research design and methods: We leveraged the International Study of Inflammation in COVID-19 (ISIC), a multicenter observational study of 2,044 patients hospitalized with COVID-19, to characterize the impact of DM on in-hospital outcomes and assess the contribution of inflammation and hyperglycemia to the risk attributed to DM. We measured biomarkers of inflammation collected at hospital admission and collected glucose levels and insulin data throughout hospitalization. The primary outcome was the composite of in-hospital death, need for mechanical ventilation, and need for renal replacement therapy.
Results: Among participants (mean age 60 years, 58.2% males), those with DM (n = 686, 33.5%) had a significantly higher cumulative incidence of the primary outcome (37.8% vs. 28.6%) and higher levels of inflammatory biomarkers than those without DM. Among biomarkers, DM was only associated with higher soluble urokinase plasminogen activator receptor (suPAR) levels in multivariable analysis. Adjusting for suPAR levels abrogated the association between DM and the primary outcome (adjusted odds ratio 1.23 [95% CI 0.78, 1.37]). In mediation analysis, we estimated the proportion of the effect of DM on the primary outcome mediated by suPAR at 84.2%. Hyperglycemia and higher insulin doses were independent predictors of the primary outcome, with effect sizes unaffected by adjusting for suPAR levels.
Conclusions: Our findings suggest that the association between DM and outcomes in COVID-19 is largely mediated by hyperinflammation as assessed by suPAR levels, while the impact of hyperglycemia is independent of inflammation.